My Decision Not to Explore, Pursue, Obtain or Maintain Community Employment For My Upcoming ISP Year

and in the Future and Vocational Assessment (MDE)

My Name: / Date of Birth: / Today’s Date:
- - / SC or PA Phone # & Email:
Name of My Services Coordinator (SC) or Personal Agent (PA): / Name of Brokerage or CDDP:

1) Do you believe that you can work now? Yes No 2) Do you believe that you can work in the future? Yes No

3) If the answer was “no” to #1 and/or #2, please explain why you do not believe you can work now or in the future:

4) Do you want to work now? Yes No 5) Do you want to work in the future? Yes No

6) If the answer was “no” to #4 and/or #5, please explain why you do not want to work now and/or in the future:

7) A goal of the Employment First initiative is to encourage individuals to pursue integrated employment and to help them find integrated employment. Would you like to work in integrated employment, sometimes called a community job? Would you like to learn more about integrated employment? If you answered “yes” to one or both of these questions, do not finish completing the MDE, instead, please complete a Career Development Plan. If the answer is “no” to BOTH of these questions, please explain why you have chosen not to explore, pursue, obtain or maintain integrated employment now or in the future.

8) On this chart, identify what would help you to pursue employment. At least one area (A-G) must be checked.

To pursue employment, I need help in these areas: / Use this space to record notes, thoughts or actions to be taken
A. Transportation to and from work
Check the strategies that could help you with this:
1. Getting a job within walking/rolling distance of my home
2. Using public transportation
3. Asking friends, family or co-workers for a ride
4. Getting a job on the bus line
5. Moving to an a home that is on or near a bus line
6. Asking my residential provider to get me to work
7. Requesting Transportation Through The K-Plan
8. Other, please specify:
B. Matching my skills, interest and abilities to a job: Some examples are: I don’t know of any jobs that interest me; I had a bad experience with a job; I don’t know what I am good at; The jobs I have had were tough for me to do.
Check the strategies that could help you with this:
1. Visiting my career center to learn about jobs in my community.
2. Requesting ODDS Discovery/Career Exploration
3 Requesting ODDS Employment Path Services
4. Job shadowing a friend or family member
5. Talking with my friends/ family about their jobs
6. Analyzing what contributed to having a bad job experience
7. Talking to people who have disabilities who work to find out
about their employment experience
8. Other, please specify:
C. Fear that I will lose my Social Security Disability and/orMedicaid benefits.
Check the strategies that could help you with this:
1. Scheduling an appointment with a benefits specialist who
works for VR or Disability Rights Oregon.
2. Other, please specify:
D. I have some challenges with my behavior.
Check the strategies that could help you with this:
1. Discussing Employment First and its key beliefs ,including
that everyone (including people who may be labeled as
having behavioral issues) is ready and able to work.
2. Requesting behavior support services
3. Requesting ODDS Discovery/Career Exploration
4 Requesting ODDS Employment Path Services
5. Discussing work with my behavior support professional
6. Talking with my friends and/ or family about their jobs
7. Other, please specify:
E. I have significant health problems and/or health related needs:
Check the strategies that could help you to be employed:
  1. My health problems are temporary and I am undergoing
treatment to get better – examples are chemotherapy,
recovering from surgery, etc.
  1. A job would need to meet certain criteria for my health,
examples are: need to work inside, I have allergies, etc.
  1. I need a job with a schedule that will not interfere with
reoccurring medical appointments such as dialysis, etc.
  1. Due to my health problems, I get tired after a few hours.
Examples of solutions are working part-time, etc.
  1. Because I have health-related needs through the day
(examples are: help with using the restroom, eating, etc.)
if I worked, I would need help with these activities.
6. Other, please specify:
F. I really like the people, places and things I do now and am reluctant to change my routine: Examples are: I enjoy the sheltered workshop and am worried that I won’t get to see my friends as much as I want to if I get a community job; I and/or my team are concerned that it will be hard to make friends at work; I and/or my team are concerned that I will not succeed at work; I and/or my team do not think that I am “ready” to work now or in the future.
Check the strategies that could help you with this:
1. Discussing Employment First and its key beliefs including that
everyone is ready and able to work.
2.To schedule activities with friends when I don’t work
3.To think about how I have made friends in the past
4.Job Shadowing with family and/or friends
5. Talking with my friends/ family about their jobs
6. Visiting my career center to learn about jobs in my community
7. To begin working only a few hours a week
8. Requesting ODDS Discovery/Career Exploration
9. Requesting ODDS Employment Path Services
10. Other, please specify:
G. Nothing could make me change my mind about not wanting to work for my upcoming ISP year: If you want to supplement your answers to questions 3 and/or 6 please share it in the space below.

9) If there is additional information you would like share about your decision not to explore, pursue, obtain or maintain community employment for your upcoming ISP year or in the future, please share it in the space below.

10) People who helped me to create and/or decide on my employment goals: Please type or clearly print this information.

Name / Role in My Life / Employer (Only needed if the person is paid to provide ODDS or OVRS services to you) / Phone # & Email Address

This document is accurate and reflects my desire not to explore, pursue, obtain or maintain community employment for my upcoming ISP year and in the future. I understand that I am free to change my mind about this decision at any time during the next twelve months. I also understand that by making this choice, I will not be able to receive any waiver-funded employment services, unless I change my mind and decide to explore, pursue, obtain or maintain community employment.

Instructions

The purposes of the MDE are to:

  1. Ensure that the individual has had an opportunity to make an informed choice about not working.
  2. Identify barriers that are keeping the individual from working – with the purpose of generating discussion about solutions.
  3. Document why and how this decision was made.

The MDE provides an opportunity to have an in depth conversation about the reasons that the person has chosen not complete a CDP and to identify potential solutions to barriers that are keeping the individual from exploring, pursuing, maintaining or obtaining community employment now and in the future. There may be a single barrier to employment, or several barriers to employment- all should be identified and discussed, and documented on this form. Please note that, until the person reaches retirement age (they are 60 or will turn 60 that ISP Year), each year they will need to complete a “My Declaration” and either a CDP or an MDE. Because of this, it is important that the MDE reflect the barriers that are stopping the person from working.

Questions 1-7

Review questions 1-7 with the individual and those the individual chooses to participate in the MDE process. This may include the individual’s ISP team, family, friends, etc.

Questions 1 & 2 address if an individual believes that they can work now and in the future. If the answer is no to #1 and/or #2, please explain why in Question 3.

Question 4 addresses if an individual wants to work now and Question 5 addresses if the individual wants to work in the future. If the answer is no to #4 and/or #5, please explain why in Question 6.

Question 7 If you answered “yes” to one or both of the questions below, do not finish completing the MDE, instead, please complete a Career Development Plan. If the answer is “no” to BOTH of these questions, please explain why you have chosen not to explore, pursue, obtain or maintain integrated employment now or in the future.

  • Would you like to work in integrated employment, sometimes called a community job?
  • Would you like to learn more about integrated employment?

Questions 8 & 9

Question 8 A-F are designed to address issues related to transportation to and from work, skills, interests and/or abilities, Social Security, behavior, health issues and change in routine. Each category (A-F) has suggested solutions that may be discussed or implemented now or in the future.

Question 8 G and Question 9 are designed to identify any other potential barriers to employment.

Question 10

This identifies who was involved in helping to create the MDE. This must include the individual and the individual’s SC/PA, but may also include others the individual chooses such as ISP team members, employment providers, etc.

July 10, 2014-Page 1